Individuals with depression and bipolar disorder, for example, often report images related to interpersonal problems, including isolation and victimization ( 19– 22). The correspondences between fears and intrusions, however, are not always so immediate or so closely linked. Patients with bulimia nervosa experience images of the self being overweight and unattractive and sensations such as feeling bloated ( 2, 8). Patients with body dysmorphic disorder experience exaggerated pictures of and sensations such as tingling in the body parts of concern ( 6). In other cases, images relate specifically to the physical body. In some cases, images link to catastrophic fears – physical or mental catastrophes in agoraphobia (e.g., passing out while crossing the road) ( 12, 13), making a fool of oneself in social anxiety disorder ( 4, 14), being contaminated in obsessive–compulsive disorder, vomiting in vomit phobia scenarios ( 3), or having a serious illness and dying in health anxiety ( 5, 18). For example, persecutory delusions may be accompanied by persecutory images, such as being put in an oven ( 10) or pharmacy staff tampering with medication to poison the patient ( 11). Sometimes, there is a close correspondence between imagery and patients’ verbal cognitions. Image content varies according to the disorder. Worry or anxiety about appearance can trigger images for individuals with body dysmorphic concerns ( 9), and in vomit phobia stomach sensations such as nausea or external stimuli such as seeing another person looking unwell act as cueing situations ( 3). Social situations (and their anticipation or recall) cue self-images in social anxiety disorder ( 4, 7), whereas binge eating and weight/shape concerns may activate images in bulimia nervosa ( 2, 8). Intrusive images are often recurrent and can be triggered by specific stimuli (both situational and internal). Images experienced by patients with vomit phobia can include physical sensations (e.g., being sick), auditory elements (e.g., others’ disgusted reactions), smells (e.g., bleach), and tastes (e.g., recently consumed food) ( 3). Cutaneous sensations (e.g., the clothes being tight) and organic elements (e.g., a sense of heaviness), for example, are characteristic in bulimia nervosa ( 2). Intrusive images are vivid and, although the visual elements are predominant, they often include other sensory modalities. We conclude by briefly discussing the treatment implications of this position. In this article, we summarize some of the current literature on intrusive images and then argue that one critical way in which they maintain disorders is through their representation and relationship with patients’ sense of self. Intrusive mental imagery is a transdiagnostic process ( 1) present in many psychological disorders including trauma-related disorders anxiety, mood, and eating disorders as well as severe mental health problems, such as bipolar disorder and psychosis.
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